Acute encephalitis in pediatric multisystem inflammatory syndrome associated with COVID-19

Olivotto, Sara; Basso, Eleonora; Lavatelli, Rossella; Previtali, Roberto; Parenti, L.; Fiori, Laura M.; Dilillo, Dario; Zuccotti, Gian Vincenzo; Veggiotti, Pierangelo; Bova, Stefania Maria

doi:10.1016/j.ejpn.2021.07.010

Cited by 35 publications

(48 citation statements)

References 4 publications

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“…In the present case, SARS-CoV-2 PCR and nucleocapsid antibodies were negative, highlighting lack of SARS-CoV-2 exposure. Our patient with encephalopathy and focal neurological signs on admission, focal EEG slowing and normal CSF analysis is similar to recently reported cases of acute encephalitis in the setting of MIS-C [30].…”

Section: Discussionsupporting

confidence: 89%

Multisystem Inflammatory-like Syndrome in a Child Following COVID-19 mRNA Vaccination

et al. 2021

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A 12-year-old male was presented to the hospital with acute encephalopathy, headache, vomiting, diarrhea, and elevated troponin after recent COVID-19 vaccination. Two days prior to admission and before symptom onset, he received the second dose of the Pfizer-BioNTech COVID-19 vaccine. Symptoms developed within 24 h with worsening neurologic symptoms, necessitating admission to the pediatric intensive care unit. Brain magnetic resonance imaging within 16 h of admission revealed a cytotoxic splenial lesion of the corpus callosum (CLOCC). Nineteen days prior to admission, he developed erythema migrans, and completed an amoxicillin treatment course for clinical Lyme disease. However, Lyme antibody titers were negative on admission and nine days later, making active Lyme disease an unlikely explanation for his presentation to hospital. An extensive workup for other etiologies on cerebrospinal fluid and blood samples was negative, including infectious and autoimmune causes and known immune deficiencies. Three weeks after hospital discharge, all of his symptoms had dissipated, and he had a normal neurologic exam. Our report highlights a potential role of mRNA vaccine-induced immunity leading to MIS-C-like symptoms with cardiac involvement and a CLOCC in a recently vaccinated child and the complexity of establishing a causal association with vaccination. The child recovered without receipt of immune modulatory treatment.

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Section: Discussionsupporting

confidence: 89%

Multisystem Inflammatory-like Syndrome in a Child Following COVID-19 mRNA Vaccination

et al. 2021

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“…The number of children hospitalised for COVID‐19 in just January 2022 appeared to be disproportionally higher than in 2020 and 2021 and one‐third had epileptic seizures. This was much higher than previously reported 3–5 and appears to be related to the Omicron variant.…”

Section: Figurecontrasting

confidence: 67%

Seizures may be an early sign of acute COVID‐19, and the Omicron variant could present a more epileptogenic profile

et al. 2022

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“…Although the possibility of SARS-CoV-2 infecting the central nervous system directly is still disputed, owing to the very low level of angiotensin-converting enzyme 2 (ACE-2) expression in the brain, human brain gene expression and immunohistochemistry have revealed that SARS-CoV-2 could infiltrate into the hypothalamus [ 18 ]. Interestingly, neuroimaging in children with neurologic manifestations has demonstrated only a low prevalence of acute encephalitis in MIS-C associated with Covid-19 [ 19 , 20 ]. Our patient had a normal brain CT scan, and a total recovery from his coma without any neurologic sequela, suggesting his mental status changes were from DKA.…”

Section: Discussionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome Associated with Multisystem Inflammatory Syndrome in a Child with Covid-19 and Diabetic Ketoacidosis: A Case Report

et al. 2022

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (Covid-19), has uncontrollable effects on many organs. A great number of previously published scientific reports have revealed that patients with diabetes mellitus face a more severe form of Covid-19 with a higher death rate. Here we present the case of a 13-year-old unvaccinated boy who was admitted to an intensive care unit (ICU) with a history of fever, cough, dyspnea, throat pain, nausea, and confusion that progressed to lethargy after 24 h. On clinical examination, he was in a coma with Kussmaul’s breathing, and was anuric. His blood biochemical analysis demonstrated hyperglycemia, severe metabolic acidosis, kidney failure, electrolyte disturbances, and inflammation. Chest x-ray showed pneumonia and a pleural effusion. The results of the SARS-CoV-2 real-time polymerase chain reaction were positive. The patient was diagnosed with Covid-19-induced acute respiratory distress syndrome associated with multisystem inflammatory syndrome in children secondary to his acute respiratory failure, acute kidney injury, and new-onset type 1 diabetes mellitus with diabetic ketoacidosis. He was intubated for invasive mechanical ventilation and received a normal saline infusion and continuous insulin infusion (0.1 IU/kg/h) for the treatment of his diabetic ketoacidosis. He was also treated with methylprednisolone, aspirin, and heparin, and underwent continuous renal replacement therapy for acute renal failure for 9 days. The patient was discharged from ICU on day 16 and was followed up regularly as an outpatient with daily treatment, including subcutaneous insulin injection (30 IU/day) and a calcium channel blocker for hypertension (nifedipine 20 mg/day).

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Acute encephalitis in pediatric multisystem inflammatory syndrome associated with COVID-19

Cited by 35 publications

References 4 publications

Multisystem Inflammatory-like Syndrome in a Child Following COVID-19 mRNA Vaccination

Multisystem Inflammatory-like Syndrome in a Child Following COVID-19 mRNA Vaccination

Seizures may be an early sign of acute COVID‐19, and the Omicron variant could present a more epileptogenic profile

Acute Respiratory Distress Syndrome Associated with Multisystem Inflammatory Syndrome in a Child with Covid-19 and Diabetic Ketoacidosis: A Case Report

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